Report urges Florida to crack down on ALFs

With Florida's elderly population expected to boom in the next two decades, state regulators must crack down on rogue assisted living facilities by shutting down homes where residents die from abuse, slapping harsher fines on places that repeatedly break the law and boosting the qualifications of people who run ALFs, a legislative study says

A report released by the state Senate calls for sweeping changes in oversight of ALFs, asking lawmakers to improve a state system that's woefully underfunded, allows caregivers to work with "inadequate training" and relies on "deficient'' enforcement to protect thousands of frail residents.

"The rotten apples need to be shut down, and (regulators) were not doing it,'' said Sen. Eleanor Sobel, a Hollywood Democrat and vice chairwoman of the Health Regulation Committee, which headed the investigation. "The Agency for Health Care Administration needs to step up to the plate and do the job they're supposed to do."

The release of the report is the latest effort by elected leaders to overhaul Florida's oversight of ALFs, which has been severely criticized for allowing some of the worst homes to stay open.

The study, carried out by Senate staffers over the past two months, was prompted by a Miami Herald investigation in May that found that dozens of vulnerable residents died of abuse and neglect in homes — nearly one a month since 2002 — and that the worst facilities were still in business.

Among the study's key recommendations: strip the AHCA of its discretion to bargain down punishment when inspectors find the most serious abuse — such as death or serious injuries from neglect — and compel the agency to take tougher action to close homes.

The report also recommended that the AHCA be forced to impose severe fines, ban new admissions and suspend licenses when a home's negligence "presents a threat to the health, safety or welfare of a client."

Among the report's findings:

• The health care agency is failing to keep up with inspections of the state's 2,956 ALFs.

• Regulators must ramp up inspections of Florida's most troubled homes, including those that care for residents with chronic mental illness, where many of the neglect and abuse deaths occur.

• Sixty percent of residents with severe dementia, such as Alzheimer's disease, wander from homes, and caregivers are ill-equipped and inadequately trained to handle such residents.

The problems with the state's enforcement come as the number of elders in Florida continues to increase — from 3.3 million today to 4.5 million a decade from now — with many of those seniors choosing to move to assisted living facilities, the report says.

To meet those challenges, the report urges lawmakers to seek ways to improve enforcement, including raising fines on homes that repeat the same violations.

The Herald found that at least 100 homes that care for people with mental illness were caught by regulators using illegal restraints, including doping residents with tranquilizers, tying them with ropes and locking them into isolation closets — and then were caught doing it again.

The 35-page report described a dozen deaths detailed in the Herald series, including the case of a 74-year-old woman bound to her bed, the restraints pulled so tightly that they ripped into her skin and killed her, and a 75-year-old man with Alzheimer's who was torn apart by alligators after wandering from his facility for the fourth time.

AHCA Secretary Elizabeth Dudek said she agrees with the proposal that regulators take harsher actions when inspectors turn up egregious abuses.

She also favored the report's recommendation that regulators ratchet up inspections of the worst facilities, while conducting abbreviated exams of the less troubled homes.

The Herald found that as the number of facilities grew across Florida — 550 new ones in the past five years — the AHCA failed to keep up with the growth, cutting inspections by 33 percent during the same period.

Another problem area targeted in the report: the qualifications for people running ALFs, which are less than the requirements for barbers, cosmetologists and auctioneers in Florida.

In addition to boosting qualifications, the report recommends that the AHCA create a five-star rating system for ALFs, similar to the one used for nursing homes, to help consumers choose where to place loved ones.

Dudek said she expects the report to be reviewed by lawmakers, as well as by Gov. Rick Scott's task force, which was formed in June to also probe the problems outlined in the Herald series.

Since the series, the AHCA has slapped admission bans on troubled facilities and cut state funding to homes at three times the rate of prior years.

Sen. Mike Fasano, a member of the health committee, said he will push for a change in law requiring the AHCA to take immediate action when turning up abuse deaths.

"You don't have the option" to leave them open anymore, the New Port Richey Republican said. "You must shut them down."